Evaluation of haematuria

Commonest benign causes:

• post exercise
• Menstruation
• UTI

Need to exclude malignancy.
Investigations

• Urine for dysmorphic cells.
  • Phase contrast microscopy is best.
  • Positive dysmorphic cells suggests glomerular bleeding.
• Complement levels
  • Low complement levels are seen in nephropathies of SLE, infective endocarditis and PSGN
• ASOT and antiDNAse-B are seen after streptococcal infection.

CO poisoning increases Alveolar arterial O2 gradient.
No vasoconstriction in CO poisoning.

• Pytiriasis is caused by malassezia species.

[!INFO] more info about sleep stages
REM sleep is non considered "restful" sleep. Brain metabolism increases and EEG is similar to an awake individual. REM Sleep disorder has impaired muscle atonia so that people act out dreams.
Sleep walking (somnambulism) is a disorder of NON-REM sleep.

• Lipids -> increase lipolysis by increasing activity of hormone sensitive lipase.
  • It is also mildly ketogenic.
• Proteins -> Increased protein synthesis, directly increases cellular influx of amino acids
  Overall, GH shifts metabolism towards fat usage and carbohydrate preservation.

• Metabolic rate is increased (but stimulating cellular metabolism and increasing skeletal muscle mass)
• serum cholesterol is reduced.
• Rise in plasma phosphorous, positive nitrogen balance (but lower serum amino acid levels)
• ⭐Decrease in blood urea nitrogen.
• Apparently, there's an increase in urine ammonia excretion despite a positive nitrogen balance. Source and Source

• Its most important biological action is to promote enterocyte differentiation and the intestinal absorption of calcium.

3. peripheral oedema.
4. Other associations
   • (hyperlipidaemia and thrombotic disease may also be present)
     • Elevated LDL and TC is the most characteristic feature.Source

Source

• Internal capsule strokes are differentiated from cortical strokes by the absence of cortical deficits.

  • Cortical deficits are as seizures, aphasia, agnosia, and dysgraphia, apraxia, alexia, and amnesia, neglect syndromes etc. and arm > leg weakness if weakness is present. (leg > arm weakness suggests cortical stroke, leg = arm weakness suggests internal capsule stroke.)

• Typical internal capsule stroke syndromes are

  1. Pure motor stroke (i.e hemiparesis)
  2. Hemiparesis with ataxia
  3. Clumsy hand - dysarthria

• Blood supply of the internal capsule:

  • Lipohyalinosis of perforating arteries is the most common cause of lacunar strokes
    LS = lenticulostriate

6. hemianopic visual loss (is an anterior circulation symdrome! not posterior circulation)

[!INFO] Recurrent artery of Huebner

The Recurrent artery of Heubner is a penetrating branch of ACA arising from the A1-A2 junction or proximal A2. It supplies parts of the internal capsule and caudate nucleus. The occlusion of the Recurrent artery of Heubner produces opposite site faciobrachial MONOPARESIS* due to the internal capsule involvement.Source

3. Language comprehension
4. Understanding social cues
5. Emotional regulation -> possibly due to involvement of the amygdala which is located in the medial temporal lobe.

Lactose intolerance

• Occurs due to deficiency of lactase enzyme.

• No weight loss or malabsorption

• pain, flatulence, borborygmi after ingesting lactose containing meal.

• Diagnosis: hydrogen breath test.

• Lactose is a disaccharide. Dietary intake decreases from infancy to adulthood.

• It's broken down by intestinal lactase to glucose and galactose which are both absorbed by intestinal SGLT-1. Failure to break down lactose reads to passage into the colon where bacterial activity converts it to short chain fatty acids and hydrogen gas. -> symptoms of bloating, flatulence, diarrhoea few hours after ingesting lactose. (?despite the process occuring in the colon)

• Soluble end products of bacterial metabolism cause osmotic diarrhoea. Source

It is the most common cause of lactase deficiency, also known as lactase non-persistence. There is a gradual decline in lactase enzyme activity with increasing age. Enzyme activity begins to decline in infancy, and symptoms manifest in adolescence or early adulthood.

• [[2021-SBR-November#Coeliac disease|Coeliac Disease]]

• Gluconeogensis in Cirrhosis

• In cirrhosis, the rate of hepatic gluconeogensis is increased and glycogenolysis is decreased. Source

• Mnemonic: "Back-up" -> upper half of the nucleus has 'back up' innvervation by the contralateral cortex.
• 

[[2020-NOV-BasicSciences#Lactose intolerance|Lactose Intolerance]]